A 'plane' explanation of anterior cruciate ligament injury mechanisms: a systematic review.
ABSTRACT Although intrinsic and extrinsic risk factors for anterior cruciate ligament (ACL) injury have been explored extensively, the factors surrounding the inciting event and the biomechanical mechanisms underlying ACL injury remain elusive. This systematic review summarizes all the relevant data and clarifies the strengths and weaknesses of the literature regarding ACL injury mechanisms. The hypothesis is that most ACL injuries do not occur via solely sagittal, frontal or transverse plane mechanisms. Electronic database literature searches of PubMed MEDLINE (1966-2008), CINAHL (1982-2008) and SportDiscus (1985-2008) were used for the systematic review to identify any studies in the literature that examined ACL injury mechanisms. Methodological approaches that describe and evaluate ACL injury mechanisms included athlete interviews, arthroscopic studies, clinical imaging and physical exam tests, video analysis, cadaveric studies, laboratory tests (motion analysis, electromyography) and mathematical modelling studies. One hundred and ninety-eight studies associated with ACL injury mechanisms were identified and provided evidence regarding plane of injury, with evidence supporting sagittal, frontal and/or transverse plane mechanisms of injury. Collectively, the studies indicate that it is highly probable that ACL injuries are more likely to occur during multi-planar rather than single-planar mechanisms of injury.
- [Show abstract] [Hide abstract]
ABSTRACT: It has been proposed that the performance of athletic tasks where normal motion is exceeded has the potential to damage the anterior cruciate ligament (ACL). Determining the expected or 'normal' kinematic profile of athletic tasks commonly used to assess ACL injury risk can provide an evidence base for the identification of abnormal or anomalous task performances in a laboratory setting. The objective was to conduct a systematic review of studies examining lower limb kinematics of females during drop landing, drop vertical jump, and side-step cutting tasks, to determine 'normal' ranges for hip and knee joint kinematic variables. An electronic database search was conducted on the SPORTDiscus(TM), MEDLINE, AMED and CINAHL (January 1980-August 2013) databases using a combination of relevant keywords. Studies identified as potentially relevant were independently examined by two reviewers for inclusion. Where consensus could not be reached, a third reviewer was consulted. Original research articles that examined three-dimensional hip and knee kinematics of female subjects during the athletic tasks of interest were included for review. Articles were excluded if subjects had a history of lower back or lower limb joint injury or isolated data from the female cohort could not be extracted. Two reviewers independently assessed the quality of included studies. Data on subject characteristics, the athletic task performed, and kinematic data were extracted from included studies. Studies were categorised according to the athletic task being examined and each study allocated a weight within categories based on the number of subjects assessed. Extracted data were used to calculate the weighted means and standard deviations for hip and knee kinematics (initial contact and peak values). 'Normal' motion was classified as the weighted mean plus/minus one standard deviation. Of 2,920 citations, a total of 159 articles were identified as potentially relevant, with 29 meeting all inclusion/exclusion criteria. Due to the limited number of studies available examining double-leg drop landings and single-leg drop vertical jumps, insufficient data was available to include these tasks in the review. Therefore, a total of 25 articles were included. From the included studies, 'normal' ranges were calculated for the kinematic variables of interest across the athletic tasks examined. Joint forces and other additional elements play a role in ACL injuries, therefore, focusing solely on lower limb kinematics in classifying injury risk may not encapsulate all relevant factors. Insufficient data resulted in no normal ranges being calculated for double-leg drop land and single-leg drop vertical jump tasks. No included study examined hip internal/external rotation during single-leg drop landings, therefore ranges for this kinematic variable could not be determined. Variation in data between studies resulted in wide normal ranges being observed across certain kinematic variables. The ranges calculated in this review provide evidence-based values that can be used to identify abnormal or anomalous athletic task performances on a multi-planar scale. This may be useful in identifying neuromuscular factors or specific muscular recruitment strategies that contribute to ACL injury risk.Sports medicine (Auckland, N.Z.). 03/2014; 44(6):815-832.
- [Show abstract] [Hide abstract]
ABSTRACT: Less optimal sagittal plane movement patterns are believed to increase knee injury risk in female athletes. To facilitate clinical screening with a user-friendly method, the purpose of the present study was to examine the temporal relationships between two-dimensional measured sagittal plane kinematics and three-dimensional joint moments during the double-leg drop vertical jump (DVJ) and single-leg DVJ (SLDVJ).The Knee 12/2014; · 2.01 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Background Alterations in sagittal plane landing biomechanics in the lower extremity has been observed within the chronic ankle instability population. Interestingly, a potential link between the risk of anterior cruciate ligament injury and ankle sprain history has been proposed. However, it is not known if the observed biomechanical changes in lower limbs associated with ankle instability could mimic factors related to the mechanism of anterior cruciate ligament injury. We investigated the influence of chronic ankle instability on anterior tibial shear force, lower extremity sagittal plane kinematics, and posterior ground reaction force in a jump landing task and attempt to identify a potential biomechanical relationship. Methods Nineteen participants with self-reported chronic ankle instability and 19 healthy control participants performed a vertical stop jump. Peak anterior tibial shear force was calculated during the first landing of the stop jump, with lower extremity sagittal-plane kinematics and posterior ground reaction force measured at peak anterior tibial shear force. Independent t-tests, multiple liner regression models, and Pearson bivariate correlation were used for statistical analysis. Significance was set a priori at P < .05. Results The chronic ankle instability group demonstrated less knee flexion at peak anterior tibial shear force compared to the control group (P = .026). No group-differences were found for peak anterior tibial shear force or the other biomechanical variables. Knee flexion angle was moderately correlated with peak anterior tibial shear force (r = -0.544, P = .008); however, the contributing factor that the most explaned the variance in peak anterior tibial shear force was posterior ground reaction force (R2 = 0.449; P = .002) in the chronic ankle instability group. Interpretation Our findings indicate that the chronic ankle instability group may be exhibiting altered knee function during functional movement. Screening movement patterns at the knee joint during a jump landing task in individuals with chronic ankle instability may help develop preventative measures for future joint injury throughout the kinetic chain.Clinical Biomechanics 10/2014; · 1.88 Impact Factor